Prescription Drug Abuse

Prescription Drug Abuse Introduction. When we think of drug addicts and abuse we normally think of people who take the common street drugs such as cocaine, crack, heroine, or other illegal drugs. However most people dont realize or take seriously the growing number of abusers of prescription drugs currently in our country. There is a common misconception that just because a doctor prescribes a certain drug that that is somehow safer and different than using the so-called street drugs. After all, you are being given a prescription to take the drug by your physician, and it is not illegal or a crime. However, we must realize that addiction isnt limited to just illicit drugs on the street, but often doctor prescribed medications as well. Prescription drugs have improved and saved countless numbers of lives over the years as many new breakthroughs have been achieved in science and medicine in treating a variety of known diseases. â€Å"However, using these drugs without the supervision of a physician or for purposes different from their intended use can lead to serious adverse consequences, including death from overdose and physical addiction. Because many prescription drugs are often opiate based, when abused, these drugs can be as addictive and dangerous as illegal drugs.† 1) (Pat Moore Foundation | Prescription Drug Abuse, 2009). According to (M.D ,Volkow, 2005), director at the National Institute on Drug Abuse, 2) â€Å"an estimated 48 million people (ages 12 and older), have used prescription drugs for non-medical reasons, which represents approximately 20 percent of the U.S. population.† Additionally, 3) â€Å"in 2000, about 43 percent of hospital emergency admissions for drug overdoses (nearly 500,000 people) happened because of misused prescription drugs, and in â€Å"2006 alone, 700,000 emergency room visits were attributed to prescription drug overdoses.† 4) (Thibodeau, 2009). This type of drug abuse is increasing at an alarming rate because of their widespread availability, including online pharmacies which have made it much easier for anyone regardless of age to acquire drugs without a prescription. (Prescription Drug Abuse Information | Drug Rehab Programs, 2009). 3) â€Å"One of the most common and primary methods of obtaining prescription drugs by addicts is by doctor shopping according to the Drug Enforcement Administration (DEA).†5) This method refers to a person who continually searches out different doctors to prescribe the same medications in order to feed their addictions. I think most of us either know or have known individuals or even family members who have resorted to this type of behavior in order to get prescription drugs for this purpose. The most common types of drugs that are often abused are central nervous system depressants such as benzodiazepines or tranquilizers, frequently prescribed for anxiety and sleeping disorders, opioids and narcotics for pain relief, and stimulants such as those given for attention deficit hyperactivity disorder, (ADHD), narcolepsy, and obesity. 6) (Prescription Drug Abuse Chart Drugs of Abuse and Related Topics NIDA, 2009) â€Å"For example, U.S. prescriptions for stimulants (including those taken for ADHD) increased from around 5 million in 1991 to almost 35 million in 2007. Prescriptions for opioid painkillers such as oxycodone (OxyContin) and hydrocodone (Vicodin) increased from 40 million in 1991 to 180 million in 2007.† 7) (Mayo Clinic, 2008). I feel the reasons for this significant increase in prescription drug abuse is simple. We live in a society today that tells you a pill can cure and solve all of your problems no matter what they are. All we have to do is turn on the television and see the constant bombardment of advertisements for the latest prescription drugs on the market. As a result, the pharmaceutical industry is making billions of dollars off of people and is certainly not going to complain, thus encouraging and driving the epidemic even more. Furthermore, these drugs are relatively easy to obtain and are socially acceptable by the vast majority of the public compared to illegal drugs. In just the past several years, we have seen the emergence and proliferation of many â€Å"pain clinics† throughout the United States. Although not all are bad, some of these facilities as stated by 8) (Silverman Brown, MD, 2009), â€Å"are often non-physician owned and operate just inside the law. The physicians who practice in these facilities are rarely accredited through board certification processes, and many take no insurance and advertise confidential, cash only services. Some even advertise armed guards in the waiting rooms. With no oversight, these facilities serve as a source for a continuous supply of controlled substances to often times addicted and sometimes naÃÆ' ¯ve people. It is not uncommon to find patients of these facilities receiving tens of thousands of milligrams of opioid medications each month.† With these types of programs and clinics operating and encouraging such drug abuse, I feel that the people who really need these medications are often the ones who suffer, such as individuals with painful terminal diseases and illnesses like cancer. I experienced this first-hand with my mother several years ago when she was diagnosed with terminal lung cancer that had metastasized to her bones, and helplessly watched her suffer from pain. While she was undergoing radiation treatments at a cancer clinic, her doctor there stated that she should use Advil to help with her pain and that the government was cracking down on schedule drugs that were prescribed. My response to this is, if cancer patients cant get the necessary pain medications they desperately need, yet addicts can get all they want, then there is something very wrong with this country we live in and our health care system. Conclusion. What is important to recognize and become aware of about prescription drug abuse is that it is much the same as other forms of illegal drug abuse such as cocaine or heroin, and no one is immune. It can be just as dangerous and deadly as other illicit drugs, and affects individuals of all ages, races, gender, and socio-economic backgrounds. It can also destroy families, jobs, and homes as well as having fatal health consequences. In fact, use of prescription drugs now causes more deaths than heroin and cocaine combined, according to the U.S. Drug Enforcement Administration.† 9) (Treatment Solutions Network, 2009). Furthermore, with the recent tragic and untimely deaths of celebrities such as Michael Jackson, Anna Nicole Smith, and Heath Ledger related to prescription drug abuse, I feel this problem is finally being brought to the forefront and exposed, bringing a much needed awareness to the dangers and consequences of abusing prescription drugs. References: 1) Pat Moore Foundation | Prescription Drug Abuse. (n.d.). . Retrieved December 6, 2009, from http://www.patmoorefoundation.com/prescription-drug-abuse 2 M.D ,Volkow, N. (2005). NIDA Research Report Series Prescription Drugs: Abuse and Addiction. Retrieved December 6, 2009, from http://www.drugabuse.gov/ResearchReports/Prescription/Prescription.html 3) Prescription Drug Abuse Information | Drug Rehab Programs. (2009). . Retrieved December 6, 2009, from http://www.prescription-drug-abuse.org/ 4) Thibodeau, D. (2009, October 20). Prescription drug abuse now tops illegal drug use | GoDanRiver. Retrieved December 7, 2009, from http://www2.godanriver.com/gdr/news/local/danville_news/article/prescription_drug_abuse_now_tops_illegal_drug_use/14771/ 5) Drug Addiction Doctor Shopping Chronic Pain Medication Addiction. (2009). . Retrieved December 6, 2009, from http://www.drug-addiction.com/doctor_shopping.htm 6) Prescription Drug Abuse Chart Drugs of Abuse and Related Topics NIDA. (2009). . Retrieved December 6, 2009, from http://www.nida.nih.gov/DrugPages/PrescripDrugsChart.html 7) Mayo Clinic. (2008). Prescription drug abuse MSN Health Fitness Addiction|Quit Smoking. Retrieved December 6, 2009, from http://health.msn.com/health-topics/addiction/articlepage.aspx?cp-documentid=100211994 8) Silverman, MD, S. M., Brown, MD, L. (2009). Prescription Drug Abuse: In the US and Florida. Retrieved December 7, 2009, from http://www.hgexperts.com/article.asp?id=6649 9) Treatment Solutions Network. (2009). Prescription Drug Abuse and Addiction. Retrieved December 6, 2009, from http://www.treatmentsolutionsnetwork.com/prescription-drug-abuse.html Prescription Drug Abuse Prescription Drug Abuse Sophia Ranta   Ã‚   Combing through the stories on the internet, I came across a shocking, testimonial of a woman who became addicted to OxyContin. Her name was Cheryl. She suffered from Fibromyalgia, which caused her to be in constant pain. When her pain became too unbearable, she went to see her family physician. Immediately, her physician prescribed her OxyContin, but stressed how important it was to follow the correct amount of dosage. At first, she was careful and cautious. Very quickly, Cheryl liked the feeling of not being in pain anymore. She craved the drugs potency, so she began abusing the drug. Some of the side effects that Cheryl suffered from were: weight loss, black-outs, isolation, no personal hygiene care, and general chaos all around her. Even though she visited her doctor every month, he never spent more than 10 minutes with her. She was able to trick him into writing a new prescription every time. Eventually, the way she broke her addiction was when she overdosed and suffered from ca rdiac arrest. The doctors were able to save her life.   Then she began the long road of recovery and rehabilitation. Since the administration of opiates is often unintentionally overused and abused, with addictions abounding, a new perspective is needed to create appropriate care plans for patients. First and foremost, in order to gain a new perspective, it would be helpful to obtain a greater understanding of prescription opiate abuse. ONeil and Hannah describe prescription drug abuse as the use of a legend drug in a way not intended by an authorized prescriber of the medication. The intent of prescription drug abuse is to obtain an altered state of mood or behavior. Prescription drug abuse frequently involves circumventing the intended route of drug administration. This is a statement that gives a clear understanding of what drug abuse is as a whole. Opiates are prescribed by doctors to control pain. With the prescription of opiates there is a specific individualized care plan that doctors carefully go over with each patient. There are two sides to prescription opiate abuse: intentional and unintentional. Intentional abuse is having the mind set of misusing the prescription. Patients who intentionally manipulate their care plan do so because they desire the high that comes fro m using the drug. A second reason, people choose to self-medicate is to dull emotional pain. The other form of opiate abuse is unintentional. Patients taking opiates due to pain may take more than their prescribed amount because they think they can cure the cause of their pain. This inadvertently leads to addiction. Having a greater understanding of opiate abuse will provide knowledge in accessing whether an individual is addicted to their prescription or not. Next, this new perspective requires an understanding of how the brain is negatively impacted by opioids. Narcotics and opiates can become extremely addictive. But how does that work within the brain and all the science behind it? Hagaman gives an excellent representation of how the brain is affected from opiate usage. Opiates are considered extremely addictive and this addiction can affect the structure and function of the brain. Opiates can alter the brain and affect ones motivation and emotions. The brain changes over time and hence a persons behavior changes. Moreover, if one uses a high enough dose of drugs, frequently enough, and over a long period of time, the drugs can change the way the brain works. The way in which the nerve cells communicate is changed so a compulsive, out of control use develops despite experiencing some of the many side effects. More specific effects of opiates on the brain include changes in the synapses and shapes of brain cells. Chronic use is linked w ith structural changes in the size and shape of specific neurons. That is to say that there is a difference noticed in the brain between a chronic opiate user and an occasional user (Hagaman). The human brain is a complex organ that when manipulated, can affect the entire body and throw it off balance. The science of the manipulation of the brains neurotransmitters when exposed to narcotics is explained. Narcotic painkillers bind to opiate receptors which are typically bound by special hormones called neurotransmitters. When painkillers are used for a long period of time, the body slows down production of these natural chemicals and makes the body less effective in relieving pain naturally. That is because narcotic painkillers fool the body into thinking it has already produced enough chemicals as there becomes an overabundance of these neurotransmitters in the body. Existing neurotransmitters have nothing to bind with, as the drugs have taken their place on the opiate receptors (Ef fects 2015). Thus, the brain produces less of its own neurotransmitters to relieve pain, and becomes dependent upon the opiates. The human brain is a delicate organ that when distorted, struggles to regain normal cognitive function and the ability to maintain homeostasis for survival.   Other organs can also be injured. Painkiller use and abuse also can affect nerve cells. Additionally, based on the manner in which the drug is used, painkiller abuse can cause long-term heart damage and increase the likelihood of a heart attack (Effects 2015). Medical care personnel need to fathom the perils narcotic painkillers can have on the human body. It is necessary for health care workers to understand how the brain is negatively impacted by narcotics. Third, to continue building this new model, education is necessary to teach about true addiction and the need to create appropriate medical care solutions. Society today sees drug abuse only coming from illegal drugs and not from prescribed drugs. Opiates are one of the most often prescribed pain medications. The abuse of opioid drugs is a public health epidemic that has been growing since the mid-1990s (Maxwell 2015). To recognize and stop the opiate abuse, education is necessary for the public. Having the knowledge to identify prescription drug abuse can lower the risk of addictions. Even now schools are introducing programs to explain and warn the dangers of overuse of prescription drugs. RX for Understanding is one resource widely used. This training program, resources, and tool kit empower principals, teachers, school nurses, and other specialized instructional support personnel to begin a dialogue in their schools about prescription drug abuse. Schools can use this program to i nform parents, students, and educators about the growing problem of prescription drug abuse through school assemblies, lesson plans, and informational materials for teens and parents (Embrey 2014). In time, the goal is that the general public will have a broader comprehension of the dangers of prescription drug abuse which will carry over into the medical setting. In the meantime, education must be provided to patients and family on the potency and hazards of long term use of opiates. Second, education of physicians could also greatly reduce the growth of this trend. Understanding prescribing patterns, as well as the perceptions of adverse effects associated with these agents, is crucial because these physicians play a critical role in curtailing the prescription drug abuse epidemic, said Catherine S. Hwang of the center for drug safety and effectiveness and the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, and her associates (Moon 201 5). Physicians need to be informed of the adverse pattern of prescription drug misuse as much as students. Third, health care providers require an understanding of the psychological effects of long-term drug use in order to treat patients with compassion and wisdom. If patients cannot trust their physicians, their pain may be compounded by feelings of isolation and fear (Johnson 2007). Perception is a powerful lens by which decisions and responses are made. Johnson introduces a triad of factors in understanding the psychological aspect of addiction. The first includes a patients biology (brain chemistry and genetics). The second involves self-medicating, in which patients use medications in response to feeling helpless about emotions generated in interpersonal situations or to treat a psychiatric disorder. The third aspect notes that addictive drugs may serve as a companion, substituting for meaningful relationships with other people. A physician may feel trapped by this combination of factors when the patient behaves in a subtly complex way and attempts to get his or her feeling of helplessness understood by the physician. As a result, the physician may feel compelled to issue a prescription as the only way to immediately disengage from an uncomfortable encounter. Unfortunately, this same process is likely to recur at the next visit (Johnson 2007).   Grasping a greater knowledge and understanding of the psychological side is imperative in guiding those who suffer from addiction to safety. Effective care can be given when caregivers have proper understanding of the potency and danger involved in the use of narcotics. Continuing on with education, another element in constructing this new medical perspective, is the need for health care workers to be educated to recognize signs and symptoms of pain, as well as the use of alternative methods to address pain relief. Pain demands an answer. Having pain is very common in older adults, but it is never normal. There is almost always a real problem behind pain (Resources). Understanding what causes the pain is crucial in knowing how to treat it. Arthritis and Muscle pain are quite common in the elderly. When pain is severe enough, patients may lose the ability to move comfortably or be incapable of doing activities of daily living. Sleeping may become so painful that it would not be enjoyable anymore. Pain can lead to other problems such as losing the ability to move around and do everyday activities. The sufferer may have trouble sleeping, experience bad moods, or develop a poor self-image. In addition, people with pain often become anxious or depressed. They may be at greater risk for falls, weight loss, poor concentration, and difficulties with relationships (Resources). Once understanding the patients level of pain, health care workers can formulate a plan of treatment. Health care workers need to provide different methods for relieving pain before administering addictive narcotics. Resources suggests several methods to be used first, before embarking on a long road of recovery from addictive opiates. Treatments such as physical therapy, massage, heat and/or cold packs, exercise, and relaxation therapy may be tried first (Resources). These methods are all non-narcotic options. Non-narcotics pain medication, other options are offered Acetaminophen is recommended as the safest type of pain reliever for long-term use (Resources). Acetaminophen pain medication includes the following: Ibuprofen, Aspirin, Naproxen. These treatments may be beneficial and eliminate the need for narcotics. Having a broader base of treatment options, may help to reduce the risk of addiction to opiates as well as administer comfort to the patient. A fifth point to consider with this new medical model must include detoxification as part of the plan of care. An example of this detoxification piece is the organization ISIS. Nevertheless, there is a place in primary care for community detoxification in substance misuse, as demonstrated by the primary care service pioneered at the Integrated Substance-misuse Islington Service (ISIS) by NHS Islington. ISIS is a primary care open access drug service that assesses and processes drug users for treatment. If patients have complex needs, they are directed to the appropriate services (Fernandez 2011). Patients may need to go from an acute hospital setting into a detox center before entering a skilled nursing facility for rehab. An acute hospital setting provides a quick detoxification of the body to remove the potency of the drugs by pumping the stomach for example. This gives the patient an immediate solution from the overdose of drugs. The detox center is the next step in the rehabilita tion process. The detox center offers a specific plan for each individuals needs. Patients suffering from drug abuse will go through a detoxification program provided by their local detox center. There are two types of detoxification: community and inpatient. The inpatient detoxification regimen consists of a five- to ten-day admission to a specialist centre for patients who present with a profile that is clinically risky for example, polydrug use with mental health problems. Community detoxification is for patients who have a minimal risk profile however, this often excludes patients with alcohol and substance misuse (Fernandez 2011). Fernandez gives an organized and complete layout of what a patients plan of care for detoxification should look like. Including detoxification into a patients plan of care will ensure that the process of detox is performed safely and effectively. Based on the patients individualized needs, each detox center will provide a plan of care for the rehabi litation to come. The importance of a detoxification center is to safely assist each patient with the cleansing of their body from the drug toxins. Next, the new medical model will allow for doctors to be better informed of the patients history with opiates and narcotics. When interviewing a patient about their history with pain medications, doctors and medical care workers need to have discernment about asking the right kinds of questions. Examples of questions that need to be asked would include the following. Do you have a history of seizures or epilepsy? Have you had previous treatment for alcohol dependence? What previous detoxification regimens have you completed? Do you have any mental health issues that could compromise the detoxification regimen? Have you had any recent liver function tests? (Fernandez). Other examples of questions could include: How long have you been taking narcotics? How often? What was the original prescribed amount? Do you have a history of using narcotics? Do you have any relatives that have suffered from addiction? These are only a selected few questions that should be asked of a patient with a h istory of narcotics. In determining the right kind of care plan, doctors need to better comprehend what each patient has been through. Obtaining a greater understanding of a patients history can help to distinguish what the proper treatment should be. Furthermore, this new medical model requires anger management training to better help equip those who are going through detox. Anger is known to be included in the side effects from drug abuse. Anger is a big problem for many people and its often one of the complicating factors for those struggling with addiction (Roes 2007). The anger can become compounded due to the process of detoxing that a patient must go through. Hazardous situations can occur when a patient is struggling with the detoxification. For example, the patient might try to harm themselves, lash out at the medical care workers that are trying to help them, or even family and friends who are trying to support them through the detox. Some examples of ways to help a patient decrease from anger or improve anger management are expounded upon by Roes. First, count to 10. Or 110. This simple and time-tested practice really helps. The more time a client buys by postponing anger, the more likely he/she will act rationally rath er than emotionally. Second, relaxation techniques are often helpful: deep breathing, listening to soothing music, taking a hot bath, etc. These calm the physical sensations associated with anger. Third, distraction (thinking about something else) also can help. As our thoughts turn to another topic, there are fewer thoughts to feed our anger. Finally, do something incompatible with anger. Kiss your spouse, or pet your dog. These types of activities can help displace anger with more agreeable emotions (Roes 2007).   These are just a few examples to help a patient deal with the side effect of anger. Another example is given in guiding an aggravated patient to a calm level. Keeping a log also can be helpful. If clients list what they think, how they feel, and how they choose to act in an angry situation, they can become more aware of their triggers. They also can become more aware of what thoughts feed their anger, and what thoughts starve it. The more deeply ingrained the ange r problem, the more likely it is that cognitive, rather than solely behavioral, interventions will promote lasting change (Roes 2007). Focusing on cognitive interventions can help the patient slow down to think rationally. One of the ways to help patients think rationally is to have a list of questions to ask themselves. Examples of questions could include: What just happened to make me angry? Was it what was said? How it was said? Or who said it? How am I going to respond without hurting myself or someone else? These questions can be personalized by health care workers to address the type of anger the patient is experiencing.  Ãƒâ€šÃ‚   It is essential for medical care providers to know how to assess each situation involving drug abuse and anger management. Moreover, this new medical model can be useful in understanding how cognitive therapy can aid with anger management, a secondary by-product of addiction. Roes gives a great representation of how anger management can be facilitated with the use of cognitive therapy. Cognitive therapy has proven successful for even the most severe problems of anger management. For perpetrators of domestic violence, for example, the belief that its OK to use anger, power, and control to get what you want might be a focus of therapy. Successful change to a more prosocial type of thinking would reduce both the anger and the likelihood of victimizing others (Roes 2007).   The term prosocial means being able to interact with people in a persons social setting.   Being prosocial means a persons behavior is positive and helpful when interacting with others. Those who are becoming prosocial are learning to focus on integrating positively with others, so they will be more careful to control their anger. Redirecting neurological pathways can help in correcting the damage that has been done to the brain.   Cognitive therapy can help a patient retrain their brain so that anger is not their first response. This type of therapy, overall, can reduce the amount of anger a patient experiences, because they have become better prepared to deal with situations that create anger. Cognitive therapy has proven to aid with anger management, a secondary by-product of addiction. In conclusion, a new perspective is needed to create appropriate care plans for patients suffering from prescription drug abuse. One must obtain a greater understanding of prescription opiate abuse. The brain is negatively impacted by opioids. Education is necessary to teach about true addiction and the need to create appropriate medical care solutions. The need for health care workers to be educated to recognize signs and symptoms of pain, as well as the use of alternative methods to address pain relief is essential. The plan of care must include detoxification. Doctors must be better informed of the patients history with opiates and narcotics. Anger management training should be included to better help equip those who are going through detox. Cognitive therapy can aid with anger management. As previously mentioned, Cheryl was only trying to control the pain she was experiencing. However, she loved the feeling of being pain free and was able to manipulate her doctors into continuous ly prescribing her pain medication without closely monitoring her. The personal testimony of Cheryl demonstrates the flaws of prescription opiates and the addictions that are taking place. Since the administration of opiates is often unintentionally overused and abused, with addictions abounding, a new perspective is needed to create appropriate care plans for patients that will help save lives. Work Cited Embrey, Mary Louise, and Libby K. Nealis. 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